Middle School Family Intake Form

*Please return with your student by Monday*

Student name:______________________________________________
Parent/Guardian names: _____________________________________
_________________________________________________________
Siblings/other people that live with student:______________________
__________________________________________________________
Phone: ____________________________________________________
Email: ____________________________________________________
Preferred Method of Contact:
Phone

Email

In-person

Parent Box

Other (specify)

Does your student have any extracurriculars (or other important info.
about their schedule), and on what days and times? ________________
_________________________________________________________

Are there any specific projects, lessons, trips, or other school functions
you and/or your student are interested in exploring this year? If you have
resources or connections to facilitate making these happen, do share!
__________________________________________________________
__________________________________________________________
__________________________________________________________

What celebrations, strengths, and awesomeness about your child can you
share with our teaching team? Add paper as needed .
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
On what challenges and skills would you like to see your child focus?
They can be personal, academic, or extracurricular.
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Any other information you would like to share?
__________________________________________________________
__________________________________________________________
__________________________________________________________
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